Designing for Long-Term Emotion Regulation: A Breathing Biofeedback Game for Women in Compulsory Isolation Drug Rehabilitation Centers

Paper Title

Designing for Long-Term Emotion Regulation: A Breathing Biofeedback Game for Women in Compulsory Isolation Drug Rehabilitation Centers

Publication Info

• Topic area: Digital health interventions for emotion regulation in marginalized populations.
• Keywords: Emotion regulation, biofeedback games, breathing techniques, substance use disorders, compulsory rehabilitation, gamification, long-term engagement, marginalized populations.

Background and Problem

• Problem / challenge: Women in compulsory isolation drug rehabilitation (CIDR) centers face significant challenges in emotion regulation due to cognitive impairments, shame, and low self-esteem, which increase the risk of relapse. Existing interventions like psychotherapy and breathing exercises are limited in accessibility, engagement, and long-term skill transfer.
• Significance: Effective emotion regulation is critical for breaking the addiction-relapse cycle and supporting social reintegration. However, marginalized populations in constrained environments lack accessible, engaging, and sustainable tools for emotional health.
• Motivation and related work: Prior research has shown the potential of breathing exercises and biofeedback games for emotion regulation, but these have been limited to short-term studies or populations without substance use disorders. There is a gap in designing and evaluating long-term, culturally adaptable interventions for women in CIDR centers.

Solution

• Proposed approach: A seven-day phased breathing biofeedback game using low-cost audio input, designed to improve breathing skills, strengthen self-efficacy, and sustain long-term engagement in women in CIDR centers.
• Novelty:
  1. Identification of emotional and cognitive challenges specific to women in CIDR centers and corresponding design requirements.
  2. Development of a phased breathing biofeedback game combining narrative metaphors and real-time feedback.
  3. Empirical validation of the game’s effectiveness in skill transfer, emotion regulation, and long-term engagement.
• Procedure and key techniques:
  • Conducted formative interviews with 30 residents and 4 experts to identify challenges and design needs.
  • Designed a 7-day progressive training program with personalized breathing techniques, visual feedback, and narrative elements.
  • Evaluated the system through a six-week randomized controlled trial with 60 participants, measuring anxiety, depression, breathing ability, and engagement.

Results

• Concrete findings:
  • 83.3% of participants reported improved breathing ability, with exhalation duration increasing from 4.374s to 4.586s.
  • Anxiety (GAD-7) scores dropped by 5.46 points in the intervention group, compared to 4.20 points in the control group.
  • Depression (PHQ-9) scores decreased by 5.02 points in the intervention group, compared to 5.30 points in the control group.
  • 76.7% of participants voluntarily extended gameplay beyond mandatory tasks.
• Advantage over baselines: The intervention group showed significantly greater reductions in anxiety and depression compared to the control group. Participants also demonstrated higher engagement and skill transfer into daily life.
• Experiments / evaluation: Conducted a six-week controlled study with 60 participants (30 intervention, 30 control). Measures included GAD-7, PHQ-9, exhalation duration, and self-reports. Data were analyzed using Generalized Estimating Equations (GEE) and thematic analysis.
• Limitations and future work:
  • Limited to a single CIDR center in China with a small, all-female sample.
  • Reliance on self-reports and questionnaires; future studies should include physiological markers and larger, diverse samples.
  • Need for further exploration of sustained use post-discharge and integration with family and community support systems.

Summary

This study developed and evaluated a seven-day breathing biofeedback game to support emotion regulation in women in CIDR centers. The intervention improved breathing skills, reduced anxiety and depression, and facilitated skill transfer into daily life, demonstrating high engagement and long-term potential. Key contributions include design strategies for marginalized populations, phased interventions to reduce digital dependency, and insights into contextualized emotional health support. Future work should expand to diverse populations and explore sustained use in broader social contexts.